Healthcare Provider Details

I. General information

NPI: 1447732235
Provider Name (Legal Business Name): BACK TO NU LOW T SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 HIGHWAY 11 E UNIT 1
LENOIR CITY TN
37772
US

IV. Provider business mailing address

2271 HIGHWAY 11 E UNIT 1
LENOIR CITY TN
37772
US

V. Phone/Fax

Practice location:
  • Phone: 865-816-3393
  • Fax:
Mailing address:
  • Phone: 865-816-3393
  • Fax: 865-681-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateTN

VIII. Authorized Official

Name: MS. BRENDA A BRYANT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 865-684-6812